46 replies to this topic

[Chris07]

Doubt it.
They snuck in aspirin for cardiac chest pain and pulse oximetry last year...but the fact that it's taken this long to put them in doesn't bode well for future changes.
Also, what's the point? Just like aspirin and pulse oximetry, just because it's in the scope doesn't mean we'll carry it on the ambulance or fire engine. It's all a de facto ALS skill.
I mean for crying out loud, most ambulances don't even carry AEDs here.

[randomperson139]

I mean for crying out loud, most ambulances don't even carry AEDs here.

What?! You serious?

 

We have to check we have a working AED on the vehicle before we start the shift...

[Chris07]

So do we, but it's because we provide 911 service. The only companies that carry AEDs are the ones with 911 contracts. All the other companies only provide transport between medical facilities and are not emergent.
The State and County makes companies jump through so many hoops to deploy and keep AEDs that the ambulance companies that don't provide emergency service can't justify the time, money and effort to put together an AED program.

Also note that AED does not equal Cardiac Monitor/Defibrillator. AEDs are used by low level providers (BLS and lower). Cardiac monitor/defibrillators are used by Paramedics only and are a required item in the ALS inventory.

[EmergencyFan97]

It is illegal to operate an ambulance without an AED/defibrillator in this state. Thank God.

And as to your point, yes and no. Our cardiac monitor is also an AED and manual defibrillator.

[Multibullets]

As a European I can't get my head around how the US has all the different laws and regulations in the different states. It just seems confusing to me. In the Netherlands, all PD, FD and EMS vehicles have an AED on board and all our ambulances are manned by a driver and a nurse (Paramedic) who can perform most medical procedures. Which just seems to make it all a lot easier.

[theparanoid]

As a European I can't get my head around how the US has all the different laws and regulations in the different states. It just seems confusing to me. In the Netherlands, all PD, FD and EMS vehicles have an AED on board and all our ambulances are manned by a driver and a nurse (Paramedic) who can perform most medical procedures. Which just seems to make it all a lot easier.

Well here some facts that might make it make more sense. The United states is 237.28 times bigger then Netherlands. With 18 times the population.

Now lets compare the Netherlands to some states.

First up
Netherlands Size 41,543 km2 PA 119,283 km2 So PA is bigger then Netherlands. Number of people in Netherlands 16,856,620 Number of People in PA 12,787,209

Netherlands vs ohio. Ohio is bigger at 116,096 and again slight less population 11,570,808

Netherlands vs New York. New york is bigger at 141,300 and has a higher population at 19,746,227

So basically are there state that then bigger then Netherlands. A lot are. Going to bigger in size. Population wise will be different.

Maybe try and compare the EU and if different rules and regular for EMS to United states. That a lot closer then trying to compare a country that smaller then most states to the entire United States of America.

The bottom line the reason the states regulated Emergency services is because even the make up of the state are different. With different amount of population in urban and rual areas. In fact because of that fact. the counties even have some say in how things run.

[EmergencyFan97]

Yeah, counties can have quite a bit of say in how things are run. For instance, the state of South Carolina is just fine with letting a service operate a 911 ambulance with only one certified EMT on board (and a driver, of course). But in my county, you have to have one ALS provider (defined as AEMT or Paramedic) and one additional EMT of any level to run a 911 ambulance.

[Newfoundking]

Generally speaking, the state law is the bare minimum. You'll see counties have rules, and departments have even more strict rules when it comes to operational requirements.

 

If memory serves, LAFD firefighters have to be EMTs. Minimum. That's department policy. The state law does not require this

[frm03064]

Here in NY with The current system there are 4 tiers of EMS providers:

 

Certified First Responder: 80 hour course. Basically a combination of first-aid, CPR and AED. Aimed at volunteer Firefighters.

 

EMT-Basic: 200 hour course. Can do all basic life support skills. Can give some medications (Nitro, Albuterol, Epi-Pen, Narcan, Asprin). Can insert oral and nasal airways. Can sample BG's and do Pulse Ox readings.

 

EMT-Advanced: 220 hours, can do everything the basic can do but can start an IV Line as well and use a manual defib/monitor and run a 12 lead EKG. Can also use a King Airway.

 

EMT-Paramedic: Can do everything the others can do, plus can administer a wide range of drugs, perform RSI and intubation. 

 

 

The state requires an ambulance crew to at a minimum have 1 EMT-Basic on board. The driver does NOT have to be an EMT, but MUST have CPR/AED. 

 

The county requires all ambulance crews be EMT-B's at minimum. Most agencies staff with 1 EMT and 1 Paramedic on each rig.

 

Fire departments that do not have an ambulance and dont transport have less stringent requirements. In our county ALL paid Firefighters MUST be EMT-B's or paramedics. ALL volunteers must at a minimum have CPR/AED and Red Cross First Aid. That being said most departments demand more... In our department its expected that all volunteers will complete either CFR or EMT-B within a year of finishing fire training. all of our paid staff and about 90% of our volunteers are EMT-B's.

 

I cant imagine not being allowed to take an SpO2 reading or give asprin...

[Chris07]

I cant imagine not being allowed to take an SpO2 reading or give asprin...

Stupid? Yes.

 

..but you have to look at it this way:

 

When there is an ER within 10 minutes in every direction, less is needed so less is given.

 

I don't condone that rationale, but it's unfortunately how the big wigs at the County level feel about it. The Los Angeles Area is very near the bottom of best EMS systems in the country.

[EmergencyFan97]

All levels of EMTs can perform 12-leads here, but only paramedics can manually interpret them. EMTs and Advanceds have to take the monitor's word for however it interprets the EKG. EMT-Bs here can do Kings. However, Narcan is not an EMT-B approved drug here. Neither is nitro or epi-pens, per se. The EMT can "assist" the patient with taking their own nitro or epi-pen, but cannot give nitro or an epi-pen from the ambulance.

[frm03064]

Stupid? Yes.

 

..but you have to look at it this way:

 

When there is an ER within 10 minutes in every direction, less is needed so less is given.

 

I don't condone that rationale, but it's unfortunately how the big wigs at the County level feel about it. The Los Angeles Area is very near the bottom of best EMS systems in the country.

 

 

a major hospital lies within our response district and its a 3 minute ride to the ER from just about anywhere in our district... That being said there are often times on busy days where we have to wait 5-10 minutes for ambulance to arrive on scene to transport... in those situations allowing EMT-B's to do some of the more advanced treatments and provide a few life savings meds can make a huge difference. Distance to the hospital isnt our issue... Its the availability of ambulances to transport.... We have 1 fully staffed ALS rig and 1 volunteer BLS rig covering a major suburban area... at times they get pulled into the city to cover calls when all the Rual/Metro rigs that serve the city are tied up... then we end up waiting even longer for a volunteer ambulance to come in from one of the outlying suburbs.

[gizmo719]

Stupid? Yes.

 

..but you have to look at it this way:

 

When there is an ER within 10 minutes in every direction, less is needed so less is given.

 

I don't condone that rationale, but it's unfortunately how the big wigs at the County level feel about it. The Los Angeles Area is very near the bottom of best EMS systems in the country.

 

So LA county is even farther behind the curve the Riverside. At least in Riverside county we can get an SPO2 and give Asprin

[Chris07]

So LA county is even farther behind the curve the Riverside. At least in Riverside county we can get an SPO2 and give Asprin

We got spo2 and aspirin about a year ago....but yea...it's significantly behind the curb.
I tell people to go to riverside if they get their medic...at least there you can use it. Unless you're in the fire service, having your medic in LA County is useless. You'll be doing IFTs only. At least private medics run the show in Riverside.

[CFDDIVE11]

So in LA county unless your on a FD if you have your medic license your not doing squat? Your basically a EMT again?

[Chris07]

Private medics only do hospital to hospital transfers of patients who need ALS level monitoring (ie. Cardiac Monitoring or Monitoring of IVs with certain drugs).

While some private paramedics are sent to 911 calls, they often times only function at the BLS level since the fire department is the "EMS authority" on scene.

The private compaines that transport for the fire department (most departments transport their own, but some do not) are contracted to provide a BLS ambulance to every 911 call for transport since the Fire Department provides the paramedics. Private paramedic ambulances are sometimes sent if they are closer than the nearest BLS ambulance, but they mostly function at the BLS level with the Fire Medics running the show. Sure the private medics can help with ALS leve linterventions but they have to have permission from the on scene fire medic. While rare, if a dual paramedic private ambulance arrives and the ETA for fire department paramedics is significant, the fire captain on scene can cancel the fire medics and have the private medics run the show.

 

Some rules of LA County that I find stupid:

1. In order to function as a "first-in" ALS unit on a 911 call, you must have at least 2 paramedics from the same agency on scene. This means if a private ALS ambulance arrives with 1 paramedic 1 EMT [1:1] (which is a common configuration for hospital to hospital transfer units) before a dual medic fire department unit, that private ALS ambulance cannot perform ALS level interventions since it is not a dual medic unit. If a dual medic unit was already on scene, then the medic on the 1:1 ALS unit could function at the full ALS level...or the dual medic unit could technically turn over care to the single medic on the 1:1 unit.

2. Private ambulances cannot cancel fire. If you are on a private transport ambulance and arrive on scene of a 911 call and discover the patient is okay and refuses care and transport...you have to wait for fire department to show up to tell them that the patient refuses. In which case they usually end up doing their own assessment and get their AMA signature.

3. There is little to no medical control for BLS units. Medical Control (or Base Contact) is virtually unheard of in the BLS realm.

4. In order to use Offline Medical Direction (Standing Field Treatment Protocols), Paramedics must be affiliated with an Agency approved to utilize them (the requirements for an agency to use them are fairly extensive including tons of frequent QA/Qi which is to be expected). This means that not all paramedics can use standing protocols and must make online medical direction for EVERY patient meeting ALS level criteria. While there are a few things that can be done prior to med control contact (including life-saving interventions), most drugs and interventions must be approved by the base hospital before they are administered.

5. If a fire paramedics jumps in the back, you're transporting lights and siren...even if the patient is stable and is only going ALS because of the type of complaint or protocol. The rational for this? transporting lights and siren to the hospital in all cases gets the fire medics back in service faster (despite putting everyone at risk and only saving like 2 minutes. In 2 years I've only had two occasions where the medic requested no lights and siren).

6. Work out side LA County if you're not a fire department paramedic and want to actually be a full-fledged paramedic.

7. Work outside of California if you want to experience some of the greatest EMS Systems in the country. Out shortly, California as a whole has a rather restrictive EMS system when compared to elsewhere in the country. Los Angeles is among the worst in California with Orange County a close second (although OC has been making some steps in the right direction)

[gizmo719]

yeah and a basic in colorado is pretty much a medic in california......I am really over this state

[Captain262]

Firefighter/EMT-B/HazMat Tech/Rescue Tech Just North of Pittsburgh, Pennsylvania, USA.

11 years experience

Held Positions of Lieutenant, Captain, Medical Officer, President (Currently Medical Officer and President)

Also Currently a Cardiac Monitor Tech in a Hospital

Planning on attending Police Academy in January of 2016

United States Marine Corps Veteran

[Fred03]

In my area the fire departments run EMR level response in their fire districts, the EMRs get to scene and basically do what's needed to keep the patient alive until the ambulance gets there, they also provide vitals over the radio to the ambulance. We have one ambulance in our county and its not unusual to be on-scene 20-30 minutes before the ambulance arrives. All our ambulances are provided by the private hospital and run with one EMT-B and Paramedic. As you've probably guessed we fly a LOT of people out due to long times to the hospital. Our closest hospital has only 6 ER rooms and does not have a surgeon on call 24/7 so most of the time they take a patient to one of the hospital that are farther away. Since we fly so many people each town has at least one helipad, usually at the fire station.

[EmergencyFan97]

Dear lord man, where are you from? Even in the farthest reaches of our county, we're never more than 30 minutes away from a hospital.